后内侧入路Ⅲ型中T型锁定板内固定治疗胫骨平台后外侧骨折

目的 探讨后内侧入路Ⅲ型中T型锁定板内固定治疗胫骨平台后外侧骨折的疗效。方法 采用后内侧入路Ⅲ型中T型锁定板内固定治疗19例胫骨平台后外侧骨折患者。术后10个月采用Rasmussen骨折复位解剖学评分标准来评价骨折复位质量,末次随访时采用HSS评分评价膝关节功能。结果 患者均获得随访,时间10～24个月。骨折均愈合,时间12～15周。术后均未发生内固定松动、关节面塌陷、力线丢失、切口深部感染及创伤性关节炎等并发症。术后1例由于肥胖原因关节屈伸锻炼不配合,活动度受限,加用CPM机锻炼后明显好转。术后10个月,采用Rasmussen骨折复位解剖学评分标准评价骨折复位质量:优15例,良4例;膝关节屈曲为110°～135°。末次随访时采用HSS评分评价膝关节功能:优11例,良7例,可1例,优良率为18/19。结论 后内侧入路Ⅲ型中T型锁定板内固定治疗胫骨平台后外侧骨折显露充分,有利于骨折解剖复位,疗效良好。     

后内侧及腓骨截骨双切口手术治疗胫骨平台后柱骨折疗效观察

目的探讨后内侧及腓骨截骨双切口L形钢板内固定治疗胫骨平台后柱骨折的疗效。方法自2009-08—2012-09采用后内侧及腓骨截骨双切口L形钢板内固定治疗胫骨平台后柱骨折12例,塌陷骨块复位后造成的骨缺损区以人工骨或自体骨植骨充填,以恢复关节面的平整。L形钢板塑形后置于后外侧与腓骨小头之间,软骨下排钉技术支撑塌陷骨折块。结果本组获得12~38个月随访,平均22个月。骨折愈合时间10~16周,平均13.5周。Rasmussen放射评分14~17分,平均16分,根据标准均达到解剖复位。末次随访时膝关节活动度5°-0°-135°,平均运动范围123.5°。膝关节功能Rasmussen评分22~30分,平均25.3分。结论后内侧及腓骨截骨双切口L形钢板内固定治疗胫骨平台后柱骨折显露充分,复位及固定满意,不会出现血管神经损伤及膝关节屈曲挛缩畸形,术后膝关节稳定性及功能恢复良好。     

前外侧联合后内侧入路治疗合并后髁骨折的复杂胫骨平台骨折

目的探讨前外侧联合后内侧入路钢板内固定治疗合并后髁骨折的复杂胫骨平台骨折的临床疗效。方法自2008-08—2012-12采用前外侧联合后内侧入路钢板内固定治疗31例伴有后髁骨折的复杂胫骨平台骨折,首先取后内侧入路稳定内侧柱,将后髁复位后选用克氏针、螺钉或钢板进行固定;外侧平台骨折采用常规前外侧入路复位固定骨折,存在骨缺损的患者取自体髂骨植骨。结果 31例均获随访10-24个月,平均13.8个月。骨折均获骨性愈合,愈合时间12-16周,平均14.7周。术后12个月膝关节功能HSS评分：优14例,良12例,可5例,优良率83.9%。1例出现小腿内下方感觉麻木,1例发生创伤性关节炎。结论对于合并后髁骨折的复杂胫骨平台骨折,采用前外侧联合后内侧入路钢板内固定是一种良好的手术方式,便于操作,术后疗效满意。     

膝关节后内侧入路支撑钢板内固定治疗胫骨后侧平台骨折

目的探讨膝关节后内侧入路支撑钢板内固定治疗胫骨后侧平台骨折的手术技巧及手术治疗效果。方法对15例胫骨后侧平台骨折采用取膝关节后内侧倒L形切口入路切开复位支撑钢板内固定手术治疗。结果 15例均获随访6~48个月,平均15.5个月。末次随访时膝关节功能HSS评分:优10例,良4例,可1例。结论膝关节后内侧入路支撑钢板内固定胫骨后侧平台骨折简便有效、安全,该入路是手术治疗胫骨后侧平台骨折的有效路径。     

后内侧入路治疗胫骨平台后髁冠状位骨折

目的探讨后内侧入路治疗胫骨平台后髁冠状位骨折的临床疗效。方法对16例胫骨平台后髁冠状位骨折患者采用经膝关节后内侧入路显露骨折,行T形钢板固定,对关节面塌陷者予以植骨。结果骨折获解剖复位12例,一般复位4例。16例均获随访,时间12～30个月。骨折于术后6～9个月达临床愈合。无神经、血管损伤,无内固定失效、关节僵硬、创伤性骨关节炎、畸形愈合等并发症发生。根据Merchant评分系统评定膝关节功能:优13例,良2例,可1例。结论采用后内侧入路治疗胫骨平台后髁冠状位骨折可在直视下复位关节面,固定牢靠,术后可早期行功能锻炼,并发症少,疗效满意。     

联合入路手术治疗胫骨平台骨折

目的探讨后内侧倒L形切口联合前外侧入路手术治疗胫骨平台骨折的临床疗效。方法采用后内侧倒L形切口联合前外侧入路手术治疗30例胫骨平台骨折患者。术后对膝关节功能HSS评分和胫骨平台内翻角、后倾角进行评价分析。结果 30例均获得随访,时间12～15个月。骨折均愈合,时间13～22周。术后1例出现切口感染,经清创换药后痊愈。患者术后12个月胫骨平台内翻角及后倾角均恢复良好,膝关节HSS评分为74～96分,优良率为93. 3%。结论联合入路手术治疗胫骨平台骨折可以精确复位和足量植骨以及坚强内固定,有利于膝关节早期功能锻炼,并发症少,临床疗效满意。     

改良后侧入路手术治疗胫骨平台后外侧骨折

[目的]介绍改良后侧切口手术治疗胫骨平台后外侧骨折的手术技术和初步临床结果。[方法] 2016年1月～2019年2月,对25例胫骨平台后外侧骨折采用改良后侧入路开放复位内固定。取俯卧位,行后外侧切口,经肌间隙进入,无需显露神经、血管,直视下复位骨折端,充分植骨,在比目鱼肌深层将预弯后桡骨远端掌侧T形钢板潜行插入,螺丝钉固定。[结果]所有患者均顺利手术,术中无血管、神经损伤等并发症。随访时间12～24个月,末次随访时HSS评分为67～96分,临床结果评定为优13例,良9例,可3例,优良率88%。影像Rasmussen评分为10～18分,评定优14例,良10例,可1例,优良率96%。[结论]此改良后侧入路手术治疗胫骨平台后外侧骨折,尽管显露范围有限,但手术创伤小,且能对后外侧骨折进行直视下复位、植骨和内固定。     

经后内侧入路锁定接骨板固定治疗胫骨平台后侧骨折

目的 探讨经膝关节后内侧入路锁定接骨板固定治疗胫骨平台后侧骨折的临床疗效.方法 对23例胫骨平台后侧骨折患者采用经膝关节后内侧入路显露骨折,行锁定接骨板固定.对2例合并严重前外侧平台骨折者加用前外侧入路予以复位固定;对关节面塌陷者予以自体髂骨植骨.术后早期膝关节康复锻炼.结果 患者切口均一期愈合.1例术后并发腘静脉血栓,予以抗血栓治疗后治愈.无其它并发症发生.患者均获随访,时间12～36个月.术后12个月根据膝关节HSS评分标准评定:优17例,良4例,可2例.结论 对胫骨平台后侧骨折采用后内侧入路、锁定接骨板内固定疗效满意.手术入路的正确选择、关节面骨折的解剖复位、坚强有效的内固定是手术成功的关键.     

胫骨内侧平台大块劈裂骨折手术方式和疗效分析

目的 :探讨经内侧入路保护内侧结构,两个不同方向内固定治疗以内侧大块劈裂为主的胫骨平台骨折的可行性和有效性。方法:自2010年1月至2016年1月采用膝内侧切口保护内侧软组织结构,不同方向固定胫骨内侧骨折块治疗涉及大块劈裂的胫骨内侧平台骨折患者21例,男17例,女4例;年龄27~63(39.2±3.2)岁。术前影像学检查(X线或CT)确诊,取膝关节内侧切口入路,保护膝内侧结构同时行内侧和内后侧钢板支撑内固定术;合并外侧平台骨折予外侧或外后侧切口复位固定。术后即刻根据Rasmussen放射学评分标准评价骨折复位情况,术后1年随访时根据美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分系统评定疗效。术后通过X线及临床检查判断骨折愈合时间,记录并发症及相应转归。结果:术后患者切口均Ⅰ期愈合,未见明显并发症。21例患者术后均获随访,时间10~24(17.2±1.7)个月。骨折均愈合,愈合时间为9~16(11.1±3.2)周。术后骨折复位Rasmussen放射学评分1~18(16.7±1.5)分;优16例,良3例,可2例。末次随访时HSS膝关节评分60~100(87.3±6.7)分;优18例,良2例,可1例。结论:对于大块劈裂的胫骨内侧平台骨折,内侧切口、充分保护膝内侧结构、两个不同方向支撑钢板固定方法可行,近期疗效满意。     

复杂胫骨平台骨折的手术治疗

目的探讨复杂胫骨平台骨折手术切口的选择及骨折复位方法和近期疗效。方法自2009-09—2013-06收治46例复杂胫骨平台骨折,均采用前外侧切口联合后内侧切口双钢板固定。结果术后46例均获随访,骨折术后6~10个月达到临床愈合,平均8个月,根据Rasmussen评分:优32例,良9例,可4例,差1例,优良率为89.1%。结论对于复杂胫骨平台骨折,前外侧联合后内侧入路是个很好的选择,双侧钢板可以提供坚强内固定,并允许早期膝关节运动,术中注意软组织处理和采用微创技术,最大限度地减少软组织并发症,近期疗效满意     

The posteromedial brachioplasty

Brachial dermo-lipectomy, which has been performed for several decades, became more frequent again with the advent of bariatric surgery. However, brachioplasty still raises the problem of its scars, necessary mostly in the longitudinal axis. Most of the described techniques are with a medial scar. The author's purpose is to show, with a five years follow-up, the reasons of its choice of a postero-medial scar: ease of installation of both arms in the same operative field, the better scar quality than in the medial localization and finally because it is comparatively the least visible under several incidences: not only anterior and posterior in abduction but also posterior in adduction.     

One-stage posteromedial release of congenital clubfoot

Turco's one-stage posteromedial release with internal fixation has been performed in 51 children with a total of 73 congenital clubfeet since 1973. Thirty-one children (44 feet) followed for 4-12 years were evaluated using the McKay rating system. The occurrence of good and excellent results was 70%. The relationship between these results and angles measured from roentgenograms was analyzed using multiple regression. The results showed a closer relationship to the anteroposterior talocalcaneal angle, the tibiocalcaneal angle, and the MTR angle.     

Postpartum rupture of the posteromedial papillary muscle

We report a case of postpartum severe mitral regurgitation caused by papillary muscle rupture in a female with normal coronary arteries. The etiology of papillary muscle rupture was endocarditis from puerperal fever. Clinical stabilization was achieved with extracorporeal membrane oxygenation (ECMO) followed by mitral valve replacement two days later.     

Importance of the posteromedial trapezometacarpal ligamentous complex

Pronation and supination of the human thumb has both a practical and a symbolic importance. In supination the thumb caresses but in pronation it grasps. The articular surfaces of the trapezium and first metacarpal are not congruent enough in themselves to assure pronation and supination, but their reciprocal saddle shape causes them to have two distinct orthogonal "fundamental" axes of rotation, and hence two "privileged" planes of rotation. The one corresponds to the movements of the lateral pinch grip and the other to opposition and counter-opposition of the thumb. The important ligaments are situated on both sides of the trapeziometacarpal joint. The posteromedial ligamentous complex is composed of the posterior oblique ligament, the anterior oblique ligament, the intermetacarpal ligament, and a fourth or more anteromedial ligament which we have called the retinaculometacarpal ligament by reason of its proximal insertion. It plays an essential role in suspending and anchoring the base of the first metacarpal. By its action it induces two types of motion: 1) a discrete translation of the metacarpal along the articular concavity of the trapezium in lateral pinch grip; 2) a more important motion characterised by a prosupination of 90 degrees during its rotation in the plane of opposition. The anterolateral ligament's action is restricted to strengthening the action of the posteromedial ligaments in the extreme positions of closing of lateral pinch and thumb opposition. In cases of trapeziometacarpal subluxation it prevents a complete dislocation. These various observations have significant clinical and therapeutic implications.     

Congenital posteromedial bowing of the tibia and fibula

Patterns of growth and development are presented for 33 patients with congenital posteromedial bowing of the tibia and fibula. The bowing is accompanied by shortening of the tibia and fibula, an initial calcaneovalgus deformity of the foot, and a decrease in ankle motion that does not improve with age. In general, the greater the initial bowing, the greater the ultimate extremity length discrepancy. The proportionate length differences between the normal and the bowed tibiae remained stable after the age of 12 months. This allowed a projection of anticipated extremity length discrepancy at maturity and a determination of the proper treatment. At birth the bowing varied from approximately 25 to 70 degrees, and at maturity the absolute tibial length discrepancies varied from 3.3 to 6.9 cm. Both the posterior and the medial components of the bow became markedly reduced with increasing age, but a mild residual medial portion of the bow remained. Soft tissue enlargement was observed in the posterior aspect of the affected legs in early life and developed to a relative muscle atrophy in later years.